Benign clinical behavior of immature mediastinal teratoma in infancy and childhood: Report of two cases and review of the literature

Abstract

Germ cell tumors of the mediastinum can be divided into three categories: 1) mature teratomas which have all elements at a mature level; 2) immature teratomas which are similar to the mature teratomas, but also contain immature epithelial or mesenchymal elements or blastema; and 3) embryonal tumors which contains elements which are recognized as dysgerminoma, embryonal carcinoma with or without yolk sac elements, and choriocarcinoma. Immature teratomas are the rarest type, accounting for only about 1% of mediastinal teratomas. Two cases of immature teratoma of the mediastinum occurring in infants are reported. One tumor was completely excised. The child is well without evidence of disease two years later. The other immature teratoma was unresectable. Biopsy showed it to be similar to the teratoma that was excised. No postoperative treatment was given. The tumor has not changed appreciably in size, but the child has grown normally for six years so that the tumor mass, which initially filled his chest, is now evidenced as mediastinal widening. A review of the reported cases of immature teratomas in the mediastinum shows that the prognostic value of the histologic appearance of these tumors has not been developed to the same degree as it has for teratomas in the ovary or the sacrococcygeal region. The immature teratomas that occur in infants behave as mass lesions as do the mature teratomas. Immature teratomas in the mediastinum of children in their late teens and in young adults behave as highly malignant tumors similar to the embryonal carcinomas.

Spontaneous Hemothorax Secondary to Immature Teratoma of the Mediastinum.

“…Immature teratomas are always potentially malignant, but their prognosis is influenced by the anatomic site of the tumor, patient age, and the fraction of immature elements within the tumor (1 1). Carter et al (2) noted that all patients younger than 15 years were all alive and well, except for one patient who died postoperatively, whereas those 15 years of age or older all died from their tumors within 1 year of diagnosis (2). The tumor of the present case broadly invaded the surrounding organs, and his age was mucholder than 15 years, So our case therefore, the tumor was fully suspected to be of malignant.…”

“…Immature teratoma of the mediastinum is particularly rare, with only 28 reported cases according to a review compiled by Carter et al in 1982 (2). Virtually all teratomas have been detected as an incidental finding (3).…”

Large mixed germ cell tumor in a young patient presenting as an intrapulmonary mass

“…Other prognostic factors for non-seminomatous and mixed germ cell tumors are patient age, anatomic site of the tumor, existence of metastasis, elevated beta-hCG levels, and the amount of immature tumor tissue [4,5,18,32]. The post-chemotherapy histology is another prognosticator with stepwise lower survival rates for patients with residual viable tumor, viable teratoma, viable non-teratomatous GCT components, or viable malignant somatic tumor [8,9,28].…”

Cardiac tumors in children- A review

“…Most commonly, these tumors are detected in the pericardial activity attached to the pulmonary artery and aorta (Uzon et al, 1996). The tumor size within the heart varies from 2 to 9 cm in diameter and intrapericardial tumors as large as 15 cm have been reported (Carter et al, 1982;Roberts, 1997). Cardiac and pericardial teratomas are easily detected in the fetus and neonate by echocardiography as heterogeneous and encapsulated cystic masses.…”

“…Leukemias and lymphomas may cause intramyocardial infiltration, haemorrhagic pericardial effusion, but occasionally they remain asymptomatic Carter et al, 1982). The majority of metastatic tumors remain silent but some may present with arrhythmias, cardiac failure or pericardial effusion.…”